Hot case — the bedside: titrating the vasopressor in septic shock

Presentation

You are taken to the bedside of a 60-year-old woman six hours into the resuscitation of a septic shock from a biliary source. She has received the antibiotics and the source is being controlled. She has had 2 L of balanced crystalloid, her fluid responsiveness is now exhausted (the pulse-pressure variation is 6 per cent), and she remains hypotensive at a mean arterial pressure of 58 on a norepinephrine infusion at 0.5 micrograms/kg/min. The lactate has fallen from 4.5 to 2.8 but is not yet normal, the capillary refill is 4 seconds, and the periphery is warm. The nurse asks you to adjust the vasopressor.^[4]